Full Text of the Key Note Address delivered by Dr. Ngozi Onyia, MD Paelon at the HALLMARK HMO Stakeholder's Engagement 3.0 2024
Transforming Healthcare Delivery: Integrating Customer-centric technologies for Enhanced Access and Affordability.
The Chairman, Hallmark Health Services Ltd Mr. Eddie Efekoha
Managing Director, Mrs Oladotun Adeogun
Distinguished Guests, Ladies & Gentlemen
Good morning, ladies, and gentlemen. I crave your indulgence to stand on the already established protocols. Let me begin by saying how honoured I feel about being asked to deliver the keynote address at this auspicious gathering.
Thank you, Mrs Adeogun, MD Hallmark HMO for the honour.
Had I a little more confidence in my memory and abilities, I’d say I’m amply qualified to deliver this keynote address based on my career trajectory.
I will start by introducing myself. I’m Dr Ngozi Onyia, a 1982 Medical graduate of the University of Ibadan, a Fellow of the West African College of Physicians in Paediatrics, a Certified Travel Health Physician, and an MBA from the Lagos Business School. Despite possessing an academic mind, I fortuitously found myself (asides from my training period) in the private sector. First, NITEL, and then most significantly, for 10 years (2000 – 2010), on the demand side of the value chain, as the company’s medical adviser of Nigerian Breweries Plc, in that, role I led the team that successfully transited the business from the rather opaque retainership scheme to the more transparent and value based managed care. A climate survey conducted by the HR department few years into the managed care scheme identified the managed care scheme as the number one retention factor for staff in Nigerian Breweries.
In 2010, I took a voluntary exit from Nigerian Breweries and pivoted into the supply side o as a healthcare provider when I established Paelon Memorial Hospital as the founder and pioneer MD, a role I still perform till date. Most recently, in the last three years, I serve as a non-executive director on the board of Leadway Health. Finally, at 64, I am hypertensive and so again on the demand side. All considered, I have a bird’s eye view and rounded experience of the healthcare ecosystem. An ecosystem is originally defined as a geographic area where plants, animals, and other organisms as well as weather and landscape work together to form a bubble of life. Inherent in this definition, is the concept of diverse players, actors, entities, working together; the healthcare space is no different.
Two interrelated concepts form the basis of my discussion this morning.
The first is that of using a service-based approach to develop patient centred service innovation and the other is Redefining Healthcare by creating value- based healthcare.
I will start with a quote made by our own Mrs Claire Omatseye at the recently concluded Healthcare Federation of Nigeria (HFN) Annual General Meeting: ‘Collaboration is the New Innovation’, I couldn’t agree more with her. She compared the older Nigerian musicians (Sunny Ade, Ebenezer Obey, Victor Uwaifo etc) to the younger musicians (Wizkid, Kizz Daniel, Mohbad etc). The older musicians were lone superstars carrying huge overheads, working in silos, working like elephants, and eating like ants. At best they stayed local champions. In contrast, the younger musicians who understand the concept of synergy, collaborate with each other and other actors in their field, running lean operations and getting rich together – shared prosperity. I have spent a lot of time thinking about that analogy in relation to the healthcare ecosystem and I realise that most of us play like the old musicians- local champion, lone stars, being crushed under the weight of huge overheads in the face of declining purchasing power. This must be a call to action for the industry. We cannot continue to do things the same way and expect different results. Time to think outside the box. Time to innovate. Time to get rich together.
Synergy is defined as the working together of two things, drugs for example, to produce an effect greater than the sum of their individual effect.
My first key point comes from an article I came across as I prepared for this talk, titled ‘Customer Centric Service in Healthcare’ findings from a case study by Maria Vincenza Ciasullo et al. Customer centricity puts the customer first; right at the core of businesses, providing a positive experience and building long-term relationships. It means embracing a service-based approach. A service-based approach is user centred / user led, using the right technology solutions to deliver better outcomes. It puts the users’ needs and goals at the centre of the vision, culture, and operations of the organization.
With the gradual change in demographics of healthcare in Nigeria from that of a young population with acute communicable diseases to now include a significant ageing population with chronic, non-communicable diseases, it must be business unusual. We must innovate using a service-based approach with the patient/customer at the centre to increase the value we offer. We must understand what the patient really need by involving them more in their care, the patients acting as ‘experts’ to co-produce personalized solutions. This calls for closer interactions with patients, greater involvement of patients, going beyond the traditional physician/patient dyad to include the multiple entities that are involved in the increasingly complex healthcare system, creating new opportunities for mutual value creation and foster service innovation. Integrating and applying their resources in new or different ways, this new service dominant logic aims at improving value co-creation by all actors. Innovation is thus viewed as the outcome of behaviours and interactions occurring between individuals and organizations which cooperate to achieve mutual benefit, blurring boundaries, boosting engagement between the various actors, in fulfilling the customer needs.
The traditional supplier customer dichotomy becomes redundant as each actor seeks and provide resources at the same time. Thus, all actors are resource integrators and as such, potential innovators. In this model, the customer is no longer a passing actor but an active part of the exchange process in which value creation occurs through resource integration.
Actor engagement, resource integration and value co-creation are the main features of service innovation.
Service ecosystems are in effect communities of interacting actors, who share and exchange their resources to adapt to their environment and co-evolve, enabling these service ecosystems achieve a long-lasting wellbeing, constantly changing and adapting their structure. Patient’s needs are put at the core of health service design and delivery, at various levels. The micro level between physicians and patients, the mezzo level involving organizations (such as hospitals, clinics, care homes) and patients’ associations, families, etc, and at the macro level involving public institutions, society at large, government. The customer (patient) can assume different roles acting as correspondent (to provide information or feedback) or as an ideator. In this value co-creation technology can act as a catalyst.
Bringing this all together, this paper reinforces the benefit of collaboration and synergy, it sheds light on the factors such as resource openness, resource sharing, resource recombination and institutions generation that stimulate patients to identify co-creation.
These include feedback from patients, patients’ suggestions, creating patient portals on electronic medical records, sharing medical records between organizations, sharing resources, the recognition of other players in the ecosystem and the roles they play, mutual trust and utmost good faith are some of the key success factors for the service-based/ customer centric model in the healthcare space. This paper reinforces the benefit of collaboration and synergy, it sheds light on the factors such as resource openness, resource sharing, resource recombination and institutions generation that stimulate patients to identify cocreation.
My second point is taken a book which he co-authored by Michael Porter and Elizabeth Teisberg titled ‘Redefining Healthcare, Creating Value-Based Competition on Results’. Reading this book led to a total shift in my paradigm so much so that the Vison statement of Paelon Memorial Hospital, the practice I founded in 2010 is To Redefine Healthcare in Nigeria.
Value-based healthcare is a healthcare delivery model in which all players are rewarded based on patient health outcomes, rather than the amount of healthcare delivered or revenues. The value in value-based healthcare is derived from measuring health outcomes against the cost of delivering the outcomes. Value-based healthcare is the proverbial win-win situation as the benefits extend to the patients, the providers, the payers, the suppliers, and the society.
- The patients spend less money to achieve better health.
- Providers achieve efficiencies and greater patient satisfaction.
- Payers control cost and reduce risk.
- Suppliers align prices with patients’ outcomes.
- Society becomes healthier while reducing overall healthcare spending.
Technology is the largest catalyst to both service-based and value-based healthcare models. EMR with patient portals, ability to book appointments, access their results, wearable devices to help with lifestyle modification, home monitoring devices such as glucometers, sphygmomanometers, pulse oximeters, virtual consultations amongst others are patient centric technologies that will increase access to value-based care provided using a service-based approach.
I cannot conclude without referring to the low uptake of health insurance and the ridiculously low premiums being charged. These two interrelated factors are the biggest threat to the industry. Most insurance companies are in a race to the bottom as the fight themselves to death in price wars. This is the big elephant in the room. Innovations in this space will include deductibles, co-payments, pharmacy benefits, etc. There is a need for a review of tariffs. More and more companies are moving back from managed care to retainership after 20 years. All actors in this space must come together to regroup. The unsustainably low tariffs resulting from low premiums is leading to substandard/fake medication being dispensed to patients. This is a real risk.
My Clarion call to us is Innovate or Die. Collaboration is the innovation.
Let us get rich together whilst delivering the highest value to our customers